SAM URETSKY

Narcotics Laws Don't Make Pharmacies Safer

On June 9, 2011, an armed gunman walked into the Haven Pharmacy in Medford, N.Y., killed the pharmacist, the clerk and two customers, then left with a load of narcotics. On New Years Eve, a robber entered Charlies Family Pharmacy in Seaford, N.Y., and stole narcotics.

He was followed into the parking lot by an armed, off-duty federal Alcohol, Tobacco and Firearms agent. A retired policeman who runs a nearby deli and an off-duty policeman eating at the deli also rushed to the scene.

The robber and the ATF agent were both killed. It has been reported that the retired police lieutenant shot the ATF agent, mistakenly thinking he was the robbery suspect. Moments later, the off-duty officer shot the robbery suspect.

In response to these, and thousands of other armed robberies of pharmacies nationwide, a number of proposals and advisories have been issued. These include programs to help pharmacists identify narcotics abusers, and recommendations that pharmacists not stock oxycodone, which seems to be the drug of choice for narcotics thefts. Other suggestions include keeping the drugs in a safe with a time lock that cant be opened or scattered throughout the store.

A task force has been set up to identify physicians and pharmacists who are selling narcotics improperly and patients who go doctor shopping to get prescriptions from more than one physician  although this group may include patients with severe pain who are being inadequately treated for their pain. Sen. Charles Schumer (D-N.Y.) has suggested longer jail sentences for pharmacy thefts.

Its important to recognize that narcotics are essential pain relievers. Not only are they effective in types of pain that cant be treated with other classes of analgesics, but theyre significantly safer.

In one British study, one-third of hospital admissions of patients over 65 were caused by the adverse effects of non-narcotic pain pills. Acetaminophen (brand name Tylenol) doesnt cause ulcers, but it can cause kidney failure in doses fairly close to the normal therapeutic dose (and in elderly patients theres a normal age-related decline in kidney function that can make acetaminophen even less safe). None of the non-narcotic analgesics can control severe pain such as pain from cancer or severe burns. If anything, narcotics are under-prescribed rather than over-used  but the current national increase in pharmacy robberies has led some pharmacies to simply discontinue stocking oxycodone, even though its one of the most useful pain relievers. This may not be a good idea. If an armed robber having withdrawal symptoms comes in and is told Ill have to order that for you, can you come back tomorrow? they might not be understanding about it.

While cameras and hidden alarms may help in the apprehension of armed robbers, theyre not much use protecting the pharmacist, store employees and patients. Unfortunately the two approaches that might work are not going to happen.

The first would be restrictions on firearms and tightening of the regulation that permit gun sales without a proper background check. The Seaford tragedy raises serious questions about the claim that wed all be safer if more people were armed. A serious discussion about Second Amendment rights would be useful, but the political climate makes that improbable.

In many states, a convicted felon can never regain the right to vote, but can get a concealed weapon permit. When the New York Times reviewed the records of North Carolina, they found that concealed weapons permits had been issued to at least 10 people with prior records of manslaughter and murder, and over 2,400 people with felony or serious misdemeanor convictions (excluding traffic violations).

There has always been a shortage of addiction treatment facilities, and this has become worse as the economy forced states to tighten their budgets. Outpatient maintenance programs would have to be carefully designed to prevent diversion.

There would be a groundswell of indignation at providing drugs to addicts while services to law abiding citizens are cut, but a weekly supply of methadone or other long acting narcotic is a lot less expensive than a prison sentence.

Auditing, including tests for blood levels, could detect diversion, and in this case, the medication might be life saving  even if the life saved isnt the patient the drugs are prescribed for.

Sam Uretsky writes and practices pharmacy on Long Island, N.Y. Email him at sdu01@mail.com.